2018 VIVA Medicare Select (HMO) H0154-008 By VIVA Medicare

2018 Medicare Advantage VIVA Medicare Select (HMO)

VIVA Medicare Select (HMO) H0154-008 is a 2018 Medicare Advantage or Medicare Part-C plan by VIVA Medicare available to residents in Alabama. This plan does not provide additional Medicare prescription drug (Part-D) coverage. The VIVA Medicare Select (HMO) has a monthly premium of $0.00 and has a in-network Maximum Out-of-Pocket limit of $6,700 (MOOP). This means that if you get sick or need a high cost procedure your co-pays are capped once you pay out of pocket $6,700 this can be a very nice safety net.

VIVA Medicare Select (HMO) is a Local HMO *. With a health maintenance organization (HMO) you will be required to receive most of your health care from an in-network provider. Health maintenance organizations require that you select a primary care physician (PCP). Your PCP will serve as your personal doctor to provide all of your basic healthcare services. If you need special care for a physician specialist, your primary care physician will make the arrangements and tell you where you can go in the network. You will need your PCPs okay, called a referral. Without getting a referral or services received from out-of-network providers are not typically covered by the plan.

VIVA Medicare works with Medicare to give you significant coverage beyond Part A and Part B benefits. If you decide to sign up for VIVA Medicare Select (HMO) you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from VIVA Medicare and not Original Medicare. With Medicare Advantage your always covered for urgently needed and emergency care and you receive all of the benefits of Original Medicare from VIVA Medicare except hospice care. Original Medicare still provides you with hospice care even if you sign up for a Medicare Advantage Plan.



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2018 VIVA Medicare Medicare Advantage Plan Details

Name:
VIVA Medicare Select (HMO)
ID:
H0154-008
Provider:VIVA Medicare
Year:2018
Type: Local HMO *
Monthly Premium C+D: $0.00
MOOP: $6,700




Plan Services






Health plan deductible


$0



Diagnostic procedures/lab services/imaging


Diagnostic tests and procedures $0-75
Lab services 0-10%
Diagnostic radiology services (e.g., MRI) $75
Outpatient x-rays $15



Hearing


Hearing exam $5-40
Fitting/evaluation Not covered
Hearing aids - inner ear Not covered
Hearing aids - outer ear Not covered
Hearing aids - over the ear Not covered



Preventive dental


Oral exam $0 copay
Cleaning $0 copay
Fluoride treatment $0 copay
Dental x-ray(s) $0 copay



Comprehensive dental


Non-routine services $0 copay
Diagnostic services $0 copay
Restorative services $0 copay
Endodontics $0 copay
Periodontics $0 copay
Extractions $0 copay
Prosthodontics, other oral/maxillofacial surgery, other services $0 copay



Vision


Routine eye exam $0 copay
Other Not covered
Contact lenses $0 copay
Eyeglasses (frames and lenses) $0 copay
Eyeglass frames $0 copay
Eyeglass lenses $0 copay
Upgrades Not covered



Mental health services


$250 for days 1 through 6
$0 for days 7 through 90
Outpatient group therapy visit with a psychiatrist $40
Outpatient individual therapy visit with a psychiatrist $40
Outpatient group therapy visit $40
Outpatient individual therapy visit $40



Skilled Nursing Facility


$0 for days 1 through 20
$160 for days 21 through 63
$0 for days 64 through 100



Rehabilitation services


Occupational therapy visit $40
Physical therapy and speech and language therapy visit $40



Ambulance


$250



Transportation


Not covered



Other health plan deductibles?


In-Network No



Foot care (podiatry services)


Foot exams and treatment $40
Routine foot care Not covered



Medical equipment/supplies


Durable medical equipment (e.g., wheelchairs, oxygen) 20% per item
Prosthetics (e.g., braces, artificial limbs) 20% per item
Diabetes supplies $5 per item



Wellness programs (e.g., fitness, nursing hotline)


Covered



Medicare Part B drugs


Chemotherapy 20%
Other Part B drugs 20%



Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)


$6,700 In-network



Optional supplemental benefits


No



Inpatient hospital coverage


$250 for days 1 through 6
$0 for days 7 through 90



Outpatient hospital coverage


$0-250 per visit



Doctor visits


Primary $5 per visit
Specialist $40 per visit



Preventive care


$0 copay



Emergency care/Urgent care


Emergency $80 per visit (always covered)
Urgent care $5-40 per visit (always covered)






Ratings for VIVA Medicare Select (HMO) H0154

2018 Overall Rating
Part C Summary Rating
Part D Summary Rating
Staying Healthy: Screenings, Tests, Vaccines
Managing Chronic (Long Term) Conditions
Member Experience with Health Plan
Complaints and Changes in Plans Performance
Health Plan Customer Service
Drug Plan Customer Service
Complaints and Changes in the Drug Plan
Member Experience with the Drug Plan
Drug Safety and Accuracy of Drug Pricing


Member Experience with Health Plan

Total Experience Rating
Getting Needed Care
Timely Care and Appointments
Customer Service
Health Care Quality
Rating of Health Plan
Care Coordination


Member Complaints and Changes in VIVA Medicare Select (HMO) Plans Performance

Total Rating
Members Leaving the Plan
Complaints about Health Plan
Beneficiary Access
Health Plan Quality Improvement


Health Plan Customer Service Rating for VIVA Medicare Select (HMO)

Total Customer Service Rating
Timely Decisions About Appeals
Reviewing Appeals Decisions
Call Center, TTY, Foreign Language


Staying Healthy, Screening, Testing, & Vaccines

Total Preventative Rating
Breast Cancer Screening
Colorectal Cancer Screening
Annual Flu Vaccine
Improving Physical
Improving Mental Health
Monitoring Physical Activity
Adult BMI Assessment


Managing Chronic And Long Term Care for Older Adults

Total Rating
SNP Care Management
Medication Review
Functional Status Assessment
Pain Screening
Osteoporosis Management
Diabetes Care - Eye Exam
Diabetes Care - Kidney Disease
Diabetes Care - Blood Sugar
Controlling Blood Pressure
Rheumatoid Arthritis
Improving Bladder Control
Reducing Risk of Falling
Plan - Cause Readmissions


Member Experience with the Drug Plan

Total Rating
Rating of Drug Plan
Getting Needed Prescription Drugs


Drug Safety and Accuracy of Drug Pricing

Total Rating
MPF Price Accuracy
Drug Adherence for Diabetes Medications
Drug Adherence for Hypertension (RAS antagonists)
Drug Adherence for Cholesterol (Statins)
MTM Program Completion Rate for CMR


Ratings For Member Complaints and Changes in the Drug Plans Performance

Total Rating
Complaints about the Drug Plan
Members Choosing to Leave the Plan
Beneficiary Access
Drug Plan Quality Improvement


VIVA Medicare Select (HMO) Drug Plan Customer Service ratings

Total Rating
Appeals Auto Forward
Appeals Upheld
Call Center, TTY, Foreign Language


Coverage Area for VIVA Medicare Select (HMO)

(Click county to compare all available plans)



Source: CMS.

Data as of September 5, 2017

Star Rating as of September 6, 2017.

For More Information on Ratings Please See the CMS Tech Notes Here.

Notes: Data are subject to change as contracts are finalized. For 2018, enhanced alternative may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part D benefit

Includes 2018 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.

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